肺结核并发真菌感染的临床特征及危险因素

Clinical features and risk factors of pulmonary tuberculosis complicated by fungal infection

目的探讨肺结核并发真菌感染的临床特征及危险因素。方法回顾性分析2017年1月至2020年12月南通大学附属如皋医院收治的104例肺结核患者的临床资料。所有入选者均进行曲霉培养,根据培养结果将患者分为感染组(n=25)与未感染组(n=79)。统计两组患者的临床资料,分析真菌感染的临床特征及危险因素。结果经曲霉培养结果发现,104例肺结核患者,有25例并发真菌感染,发生率为24.04%(25/104);25例并发真菌感染的肺结核患者临床表现以咳嗽、咳痰(100.00%)最为常见,其次为咯血(72.00%)、发热(36.00%)、胸痛(16.00%)、呼吸困难(4.00%);感染组住院次数>2次、反复应用广谱抗生素、长期应用糖皮质激素、合并慢性阻塞性肺疾病占比均高于未感染组,差异有统计学意义(P<0.05);两组患者性别、年龄、体重指数、吸烟史、合并糖尿病比较,差异无统计学意义(P>0.05);logistic多因素回归分析显示,住院次数>2次(β=1.626,OR=5.083,95%CI=1.951~13.242)、反复应用广谱抗生素(β=2.026,OR=7.585,95%CI=2.814~20.444)、长期应用糖皮质激素(β=1.357,OR=3.886,95%CI=1.519~9.942)、合并慢性阻塞性肺疾病(β=2.094,OR=8.120,95%CI=2.945~22.387)是肺结核并发真菌感染的独立危险因素。结论住院次数>2次、反复应用广谱抗生素、长期应用糖皮质激素、合并慢性阻塞性肺疾病的肺结核患者更易感染真菌,针对合并高危因素的患者临床需予以高度重视,以改善预后。

Objective To investigate the clinical characteristics and risk factors of pulmonary tuberculosis complicated by fungal infection. Methods The clinical data of 104 pulmonary tuberculosis patients admitted to Rugao Hospital Affiliated to Nantong University from January 2017 to December 2020 were retrospectively analyzed. All the selected subjects were cultured with Aspergillus, and the patients were divided into infection group (n=25) and non-infected group (n=79) according to the culture results. The clinical data of the two groups were counted, the clinical characteristics and risk factors of fungal infection were analysed. Results The results of Aspergillus culture showed that of the 104 pulmonary tuberculosis patients, 25 cases had fungal infection, the incidence was 24.04% (25/104). The most common clinical manifestations of 25 pulmonary tuberculosis patients with fungal infection were cough and sputum (100.00%), followed by hemoptysis (72.00%), fever (36.00%), chest pain (16.00%), dyspnea (4.00%). The proportion of hospitalization times>2 times, repeated application of broad-spectrum antibiotics, long-term application of glucocorticoid and chronic obstructive pulmonary disease in the infection group were higher than those in the non infection group, the differences were statistically significant (P<0.05). There were no statistically significant differences between the two groups in gender, age, body weight, smoking history and diabetes (P>0.05). Logistic multivariate regression analysis showed that proportion of hospitalizations>2 times (β=1.626, OR=5.083, 95%CI=1.951-13.242), repeated use of broad-spectrum antibiotics (β=2.026, OR=7.585, 95%CI=2.814-20.444), long-term use of glucocorticoids (β=1.357, OR=3.886, 95%CI=1.519-9.942), combined with chronic obstructive pulmonary disease (β=2.094, OR=8.120, 95%CI=2.945-22.387) were independent risk factors for pulmonary tuberculosis complicated with fungal infection. Conclusion The proportion of hospitalizations>2 times, repeated use of broad-spectrum antibiotics, long-term use of corticosteroids, and chronic obstructive pulmonary tuberculosis patients are more likely to be infected with fungal. The clinical needs of patients with high-risk factors need to be paid close attention to in order to improve the prognosis.